This toolkit was created by Dave Zuckerman and Katie Parker of The Democracy Collaborative, with contributions from Joshua Humphreys and Ophir Bruck of the Croatan Institute.

Nationally, health systems have an estimated $400 billion in investment assets. Redirecting even a small portion of these resources to place-based investments would shift billions of dollars toward addressing economic and environmental disparities in local communities. It would allow institutions to more effectively improve community health and well-being, even as they continue to earn a healthy rate of return. This toolkit outlines a range of strategies for how health systems are using their investment assets to help address the resource gaps that keep communities from achieving better health and well-being.

As we learn more about what families and children need to lead healthy lives, it is clear that adverse social, economic, and environmental factors, coupled with racial disparities, prevent communities from building a culture of health. The good news is that hospitals and health systems are recognizing that they have significant, untapped assets at their disposal to help address these challenges: their investment portfolios. Through place-based investing, institutions can leverage these resources to improve their communities’ overall health and well-being. This toolkit will help you get started.

Case Studies

Headquartered in San Francisco, California, Dignity Health provides below-market interest rate loans and other investments to nonprofit organizations through its Community Investment Program for community economic development projects that benefit low-income...

Headquartered in Marriottsville, Maryland (near Baltimore), Bon Secours Health System aims to invest up to 5 percent of its Long-term Reserve Fund (LRF) with intermediaries that serve low- and moderate-income communities, primarily community development...

Headquartered in La Crosse, Wisconsin, Gundersen Health System became the first health system in the world to produce more power than it consumed, six years after establishing its goal of achieving 100 percent energy independence. To finance the development...

Headquartered in Toledo, Ohio, ProMedica established the Ebeid Institute for Population Health in December 2015. The cornerstone of the Institute is a 6,500-square-foot, full-service grocery store, owned and operated by ProMedica, that offers healthy,...

Headquartered in Orange, California, St. Joseph Health provides capital in the form of loans, deposits, and other support to nonprofit organizations and programs focused on affordable housing, economic development, social services, food banks, job expansion,...

Headquartered in Livonia, Michigan (in metro Detroit), Trinity Health has been investing in its communities using low-interest rate loans for more than a decade through its Community Investment Program. Its investments total more than $35 million to date,...

Key Strategies

Utilizing institutional investment portfolios to improve community health and well-being

Place-based investors often find that the community interventions and supports needed—and the investment required to make them sustainable—are not a good fit for the highly compartmentalized and specialized offerings of the mainstream financial system, and may therefore require more patient capital and new approaches to investment analysis and capital deployment. An integrated capital stack might include investments across a range of asset classes, including cash and cash equivalents, fixed income, private equity, private debt, and real assets, as well as grants and human and social capital, such as access to mentors, learning circles, and technical assistance.

Measuring Performance and Impact

Tracking positive environmental, social, and economic outputs and outcomes specifically within your health system’s geographic footprint can help demonstrate the business impact of these investments beyond simply the financial return.

Overcoming Barriers

Promising solutions to common challenges

Place-based investments are not creating sufficient impact…

Not familiar with CDFIs or other financial intermediaries that serve the geography of our patients, or none exist….

Lack of internal capacity to monitor individual, direct loans to borrowers, or make direct investments in other asset classes….

Governance and leadership unwilling to settle for a rate of return less than the historical average of the investment portfolio…

More resources

A national nonprofit helping health systems, universities, local governments, and community foundations who wish to leverage local purchasing, hiring, and investment resources to build community wealth.

If you are interested in print copies of these toolkits, or would like to know more about how The Democracy Collaborative can support their use at your institution, please contact kparker@democracycollaborative.org.